Bbr 2778, an aza-anthracenedione endowed with preclinical anticancer activity and lack of delayed cardiotoxicity.

With the aim to provide second-generation anthracenedione analogues endowed with reduced side effects and a wider spectrum of action than mitoxantrone and doxorubicin, a large number of new molecules bearing nitrogen atoms in the chromophore was synthesized and screened in vitro and in vivo. From this screening, BBR 2778 (6,9-bis[(2-aminoethyl)amino] benzo[g]isoquinoline-5,10-dione dimaleate) emerged as the most interesting compound. BBR 2778 was tested in vitro on several murine and human tumor cell lines and showed cytotoxic potency lower than that of mitoxantrone and doxorubicin. BBR 2778 was more cytotoxic in leukemia and lymphoma cell lines than in solid tumor cell lines. Although against in vivo models BBR 2778 was less potent than mitoxantrone and doxorubicin, its antitumor activity was equal or superior (in certain tumor models) to that of the above standard compounds. In particular, BBR 2778 was curative against L1210 murine leukemia and YC-8 murine lymphoma. Moreover, it showed an antitumor activity comparable to that of mitoxantrone and doxorubicin on solid tumors. No cardiotoxic effect of BBR 2778 in animals not pretreated with anthracyclines was observed compared to standards. In light of its spectrum of activity and marked efficacy against lymphomas and leukemias over a wide dose range, together with its lack of delayed cardiotoxicity, BBR 2778 has been entered in clinical studies.

Can laparoscopic cholecystectomy be a day surgery procedure?

BACKGROUND/AIMS: Gallbladder surgery by videolaparoscopy (VL) is now able to obtain the same goals as traditional surgery, and is associated with comparable or better results both in terms of positive surgical outcome and patient satisfaction. With public health spending under growing social and administrative pressure, and continuous efforts focusing on enhancing the efficiency of both surgical instruments and operating procedures, it is a most attractive, albeit initially challenging, prospect to regard video-laparoscopic surgery as day-case surgery. Herein, the authors assess the outpatient treatment option, due to recent technical developments and relevant major organizational and professional implications, and consider the feasibility of day-case surgery projects which should soon be implemented. METHODOLOGY: From January 1994 to December 1996, 1,334 patients underwent videolaparoscopic cholecystectomy. Of these, 898 were women and 436 men. In 1,034 of the laparoscopies gas was used and 300 were performed without gas. Out of the total 1,334 patients who were submitted to the videolaparoscopic cholecystectomy procedure with or without the use of gas, 72 (5.4%) were treated on an outpatient basis. RESULTS: In our series, 93.5% of patients reported normal post-operative functions within 24 hours; 90.2% of patients were able to take oral fluid on the same day of the operation and had normal bowel peristalsis within the first post-operative day. CONCLUSIONS: The authors assess the outpatient option treatment, due to recent technical developments and relevant major organizational and professional implications, and consider the feasibility of a day-case surgery project which should soon be implemented.

[New polypropylene hernia prosthesis]. / Nuove protesi erniarie in polipropilene.

Since the first true hernioplasty performed by Edoardo Bassini more than 100 years ago (1884) all surgical reconstruction techniques have shared a common defect i.e. tension on suture line. This is the first etiologic factor of recurrent hernia. On the contrary by the use of modern prosthetic materials (mesh and plug) it is now possible to marriage all hernia repairs without distorting normal body anatomy and avoid undesirable tensions. The technique proposed is simple, efficient, characterized by a rapid performing procedure, giving way to an excellent clinical outcome: postoperative pain relief permitting the patient to resume in a short time his normal physical activities. In this paper the authors present their experience in wall defects reconstruction by means of outpatient surgery and in general anesthesia in the period spanning from 1994 to 1996. Five different types of hernia mesh in hernioplasty procedures were evaluated and used.

[Recurrent inguinal hernia. Propositions of classification and surgical strategy]. / Hernies récidivées de l'aine. Propositions de classification et de tactique chirurgicale.

We reviewed 1005 cases of groin hernia in 932 patients including 113 recurrent hernias. Eighty-seven percent of the patients were seen again one year after surgery for an evaluation of technique, results and complications. The data obtained was used to propose a simple anatomoclinical classification into three types which could be used to orient surgical strategy. Type R1 includes first relapse oblique external reducable hernia of less than 2 cm in non-obese patients: the Lichtenstine-gilbert technique is indicated. Type R2 includes inferior, direct reducable first relapse hernia of less than 2 cm in non-obese patients: the Wantz-Trabucco technique is indicated. Type R3 includes all the other forms: the Stoppa technique, or alternatively laparoscopy, is proposed.

[Use of polypropylene (Marlex) prosthesis in the surgical treatment of inguinal and crural hernia]. / L'uso delle protesi in polipropilene (Marlex) nel trattamento chirurgico dell'ernia inguinale e crurale.

High biocompatibility, low cost and easiness in use are most important reasons for the spread of biological prosthesis in inguinal and femoral hernia repairs; this fact has changed the surgical approach to this kind of pathologies. This new approach consists in re-creating a normal anatomic function of the abdominal wall, without new tension between muscles and aponeurotic structures. The authors present their experience after 379 inguinal and femoral hernia repairs between January 1992 and December 1993.

[Potential and limitations of conservative surgery in the treatment of gastric stump cancer]. / Possibilità e limiti della chirurgia conservativa nel trattamento del cancro del moncone gastrico.

In the Italian population the risk of gastric stump cancer after surgery for peptic ulcer is increased after 20-30 years. Bearing in mind that further surgery has little curative chances, we examined the series seen at the Institute of General Surgery of the University of Milan (1983-1992) to investigate whether or not patients followed-up endoscopically have a better chance of cure after surgery. Although only 10 patients were available for evaluation, it was evident that patients found at endoscopic screening in stage 0 and I (UICC classification) had a good survival after surgery. Our results support the need of strict endoscopic follow-up of resected patients 20 or more years after surgery and the need of further investigations to establish whether or not resection is useful and safe for early lesions.

Trabucco's procedure and local anaesthesia in surgical treatment of inguinal and femoral hernia.

Traditional surgical techniques base themselves on some conceptual mistakes, the first of which is that the new wall is built with lots of stitches and this is the reason for pain and long time spent in bed. The second one is that the new wall is built with the patient's muscles and aponeurotic tissues, this procedure leading to biological weakness. It is not possible to demonstrate the connection between traditional techniques and hernia recurrence, but we think that there are enough reasons to choose prosthesis technique. In all our cases of inguinal and femoral hernia the procedure applied was the Trabucco tension-free hernioplasty repair. This technique is simple, effective, rapid, the post-operative pain is reduced and all patients return to full activities rapidly. Now, with the modern prosthetic materials and new surgical techniques it's possible to repair all types of hernias and re-create normal anatomic function of the abdominal wall without new tension between muscles and aponeurothic structures. Authors show the actual trend of tension-free inguinal and femoral hernia repair, by taking into consideration risks, type of anaesthesia and surgical technique.

[Endoscopic monitoring in lung transplantation. Transplantation Group of the Maggiore Policlinico Hospital of Milan]. / Il monitoraggio endoscopico nel trapianto di polmone. Gruppo Trapianto di Polmone dell'Ospedale Maggiore Policlinico di Milano.

During the period March 1991-June 1992 5 single lung transplantations were successfully performed at the Ospedale Maggiore Policlinico in Milan. All patients underwent regular fibrobronchoscopies within the context of a complex follow-up programme in order to monitor the resolution of the bronchial anastomosis and identify the onset of intercurrent lung infections and rejections using bronchioalveolar lavage (BAL) and transbronchial biopsies (TBB). Forty-four fibrobronchoscopies were performed of which 24 for anastomotic follow-up, BAL and TBB, and 20 for the simple monitoring of the anastomosis. Fibrobronchoscopies confirmed the optimal resolution of bronchial anastomosis in 4 patients, whereas one patient showed a granulomatous anastomotic reaction which was successfully treated using local steroid injections. Although recovery was normal in one patient, kinking appeared in the bronchus of the receiving lung which was successfully treated by the insertion of Gianturco prosthesis. BAL enabled the identification of 2 CMV infections, one Pseudomonas aeruginosa, one Haemophilus influenzae and one Pneumocystis carinii infection. TBB allowed 3 cases of CMW lung infection and 7 episodes of rejection to be diagnosed. The authors' personal experience confirms the decisive role played by bronchoscopy in the follow-up of lung transplant patients. This procedure allowed bronchial anastomosis to be closely monitored and was of vital importance in the diagnosis of lung infections and rejection.

[Endoscopic laser therapy in the palliative treatment of cancer of the esophagus]. / Laser-terapia endoscopica nel trattamento palliativo del cancro dell'esofago.

Frequently when dysphagia first becomes manifest, esophageal carcinoma is already unresectable. Endoscopic laser therapy is a recently introduced method which can be used for the palliative treatment of esophageal cancer. By using the method the tumour is destroyed and the esophagus is recanalized, there is low incidence of complications, and the patient can be fed naturally thus improving quality of life. The method has been perfected over the past years and now offers excellent results.

Single lung transplantation for emphysema. Lessons learned on the field. The Lung Transplant Group of the Ospedale Maggiore of Milan.

Emphysematous patients that were once treated with double lung transplantation can now also be treated with single lung transplantation. However, single lung transplantation in emphysematous patients presents problems in lung size matching, choice of side to transplant and post-operative assistance. Analysing their own experience of three single lung transplants performed on emphysematous patients, the Authors evaluate the effectiveness of the operation, the results and the difficulties encountered. Single lung transplantation is a good therapeutic option for end-stage emphysematous patients. In these patients right lung transplantation is preferable and the donor organ should be oversized. Positive and expiratory pressure in the native emphysematous lung should be applied with extreme caution.

[Lung transplantation: a clinical reality]. / Il trapianto di polmone. Una realtà clinica.

Lung transplant has now become a viable clinical option for the treatment of irreversible end-stage respiratory failures. The first successful single lung transplant was performed by Cooper and coworkers in Canada in 1983, and the first successful double lung transplant was performed by the same group in 1986. The history of lung transplantation is followed by a discussion of the current surgical indications for single and double lung transplants. The criteria for the evaluation and pre-operative management of potential candidates are reported. The surgical techniques used for harvesting, preserving and transplanting one or both lungs are then described, including the latest procedure of sequential bilateral lung transplantation. Almost 250 patients have undergone single or double lung transplants all over the world with a survival rate of more than 65%. Lung function and exercise tolerance have satisfactorily improved. Despite a number of problems in airway anastomosis and in diagnosis and treating rejection still to be resolved, lung transplantation is rapidly gaining ground worldwide.

[The Fitz-Hugh-Curtis syndrome. Postgonococcal perihepatitis]. / La sindrome di Fitz-Hugh-Curtis. Periepatite post-gonococcica.

A case of Fitz-Hugh-Curtis syndrome (post gonococcal perihepatitis) is reported. The patient proved to be affected by a typical case of the syndrome and the approach used concentrated on an accurate diagnosis and immediate therapy carried out during laparoscopic examination. A control examination after approximately one month confirmed the resolution of both perihepatitis and symptoms. The patient is now in good health some three years following the operation.